Evidence map›Paper›PMID 25997746›Full record

Trial reportArthritis research & therapy2015

Cost-effectiveness of abatacept, rituximab, and TNFi treatment after previous failure with TNFi treatment in rheumatoid arthritis: a pragmatic multi-centre randomised trial.

Sofie H M Manders, Wietske Kievit, Eddy Adang, Herman L Brus, Hein J Bernelot Moens, Andre Hartkamp, Lidy Hendriks, Elisabeth Brouwer, Henk Visser, Harald E Vonkeman and 5 more

Open access · goldAbstract readMulticenter StudyRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Arthritis research & therapy, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 7 pooled it
8.6field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 7 syntheses or guidelines pooled it, 68 citations in OpenAlex.

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  12. Rituximab use in Rheumatoid Arthritis: A Seven-Year Retrospective Study of 52 Patients at a Saudi Arabian Hospital.Medical science monitor : international medical journal of experimental and clinical research · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 3 institutions in 2 countries.

Sofie H M MandersDepartment of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Postbus 9101, Geert Grooteplein Noord 21 (Route 114), 6500 HB, Nijmegen, Netherlands. sofie.manders@radboudumc.nl.
Wietske KievitDepartment of Health Evidence, Radboud University Medical Centre, Nijmegen, Netherlands. wietske.kievit@radboudumc.nl.
Eddy AdangDepartment of Health Evidence, Radboud University Medical Centre, Nijmegen, Netherlands. eddy.adang@radboudumc.nl.
Herman L BrusDepartment of Rheumatology, TweeSteden Hospital, Dr. Deelenlaan 5, Tilburg, 5042, AD, Netherlands. hbrus@tsz.nl.
Hein J Bernelot MoensDepartment of Rheumatology, Ziekenhuisgroep Twente, Zilvermeeuw 1, Almelo, 7609 PP, Netherlands. h.moens@zgt.nl.
Andre HartkampDepartment of Rheumatology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 's-Hertogenbosch, 5223, GZ, Netherlands. a.hartkamp@jbz.nl.
Lidy HendriksDepartment of Rheumatology, Medical Centre Leeuwarden, Henri Dunantweg 2, Leeuwarden, 8934, AD, Netherlands. l.hendriks@znb.nl.
Elisabeth BrouwerDepartment of Rheumatology, University Medical Centre Groningen, Hanzeplein 1, Groningen, 9700, RB, Netherlands. e.brouwer@umcg.nl.
Henk VisserDepartment of Rheumatology, Rijnstate Hospital, Postbus 9555, Arnhem, 6800, TA, Netherlands. hvisser@alysis.nl.
Harald E VonkemanDepartment of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Haaksbergerstraat 55, Enschede, 7513, ER, Netherlands. h.vonkeman@mst.nl.
Jos HendrikxDepartment of Rheumatic Diseases, Radboud University Medical Centre, Nijmegen, Netherlands. jos.hendrikx@radboudumc.nl.
Tim L JansenDepartment of Rheumatic Diseases, Radboud University Medical Centre, Nijmegen, Netherlands. tim.jansen@radboudumc.nl.
Rene WesthovensSkeletal Biology and Engineering Research Centre, Department of Development and Regeneration, KU Leuven, Oude Markt 13, Leuven, 3000, Belgium. rene.westhovens@uzleuven.be.
Mart A F J van de LaarDepartment of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Haaksbergerstraat 55, Enschede, 7513, ER, Netherlands. m.vandelaar@mst.nl.
Piet L C M van RielDepartment of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Postbus 9101, Geert Grooteplein Noord 21 (Route 114), 6500 HB, Nijmegen, Netherlands. piet.vanriel@radboudumc.nl.
Radboud University Medical Center · NLCenter for Rheumatology · USRadboud University Nijmegen · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionFor patients with rheumatoid arthritis (RA) whose treatment with a tumour necrosis factor inhibitor (TNFi) is failing, several biological treatment options are available. Often, another TNFi or a biological with another mode of action is prescribed. The objective of this study was to compare the effectiveness and cost-effectiveness of three biologic treatments with different modes of action in patients with RA whose TNFi therapy is failing.

methodsWe conducted a pragmatic, 1-year randomised trial in a multicentre setting. Patients with active RA despite previous TNFi treatment were randomised to receive abatacept, rituximab or a different TNFi. The primary outcome (Disease Activity Score in 28 joints) and the secondary outcomes (Health Assessment Questionnaire Disability Index and 36-item Short Form Health Survey scores) were analysed using linear mixed models. Cost-effectiveness was analysed on the basis of incremental net monetary benefit, which was based on quality-adjusted life-years (calculated using EQ-5D scores), and all medication expenditures consumed in 1 year. All analyses were also corrected for possible confounders.

resultsOf 144 randomised patients, 5 were excluded and 139 started taking abatacept (43 patients), rituximab (46 patients) or a different TNFi (50 patients). There were no significant differences between the three groups with respect to multiple measures of RA outcomes. However, our analysis revealed that rituximab therapy is significantly more cost-effective than both abatacept and TNFi over a willingness-to-pay range of 0 to 80,000 euros.

conclusionsAll three treatment options were similarly effective; however, when costs were factored into the treatment decision, rituximab was the best option available to patients whose first TNFi treatment failed. However, generalization of these costs to other countries should be undertaken carefully.

trial registrationNetherlands Trial Register number NTR1605. Registered 24 December 2008.

Indexed as

Cost-Benefit AnalysisAbataceptAntirheumatic AgentsArthritis, RheumatoidDrug ResistanceFemaleHumansMaleMiddle AgedRituximabTreatment OutcomeTumor Necrosis Factor-alphaAbataceptAntirheumatic AgentsRituximabTumor Necrosis Factor-alpha

Identifiers

PMID25997746
PMCPMC4489004
OpenAlexW2155202277

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.